JP2022525978A - Glenoid base plate and implant assembly - Google Patents

Abstract

Glenoid base plates with transverse and elongated bodies are provided. The transverse body has a first side configured to engage the patient's scapula, a second side configured to face away from the first side, and multiple anchor apertures. Have. Anchor apertures are formed between the first side and the second side. The transverse body is also arcuate or circular with an anterior portion configured to be oriented towards the anterior side of the scapula and a posterior portion configured to be oriented towards the posterior side of the scapula. It may have a perimeter. The slender body is arranged along the vertical axis between the first side of the transverse body and the joined end. The vertical axis of the oblong body is offset from the center around the circle.

Description

Incorporation by reference to any priority application Any application and all applications for which a foreign or domestic priority claim is identified in the application datasheet filed by this application shall be the US Patent Law Enforcement Regulations 1. Incorporated below by reference under Article 57.

The present application is capable of being attached to the scapula at the glenoid surface and can have anchor pegs located inside the glenoid surface and between the anterior and posterior surfaces of the scapula. , Directed to an improved glenoid base plate design.

The condition of the shoulder joint is sometimes resolved by shoulder arthroplasty. Further efforts are being made to make total shoulder arthroplasty available to patients who will benefit from such treatment. In total shoulder arthroplasty, the glenoid is typically pierced with a reamer, followed by a reamer, followed by a glenoid joint component attached to the scapula. The joint component provides a flat surface for the movement of the human head or humeral joint component.

A glenoid base plate may be used to support the glenoid joint component on the scapula. The glenoid base plate may include an anchor peg on its medial side that is configured to be inserted into the scapula as a portion that secures the glenoid base plate to the scapula.

Although the glenoid base plate is known, one challenge faced when implanting such a base plate is that the anchor pegs (or other medial processes) of the base plate are always integrated within the scapula, eg, within the scapula. It is to ensure that it is completely closed and does not extend through the posterior or anterior wall of the scapula.

Some embodiments may include an elongated body, eg, an anchor peg, that can be located on the transverse of the base plate at a position extending deep into or even deeper into the scapula just below the glenoid surface. A method of producing a glenoid base plate that can be provided is provided. The anchor peg position is the geometry beneath the glenoid fossa (sometimes referred to as the fornix geometer) to provide a long anchor peg or even the longest anchor peg that fits the part of the fornix selected for the anchor. Can match. In some cases, the position is chosen so that the anchor peg does not puncture the wall of the scapula.

In one embodiment, a glenoid base plate with transverse and elongated bodies is provided. The transverse body has a first side configured to engage the patient's scapula, a second side configured to face away from the first side, and multiple anchor apertures. Have. Anchor apertures are formed between the first side and the second side. The transverse body may also have a circular perimeter extending between the first side and the second side. The circular perimeter has an anterior portion configured to be oriented towards the anterior lateral portion of the scapula and a posterior portion configured to be oriented towards the posterior lateral portion of the scapula. The circular circumference may have a center. The slender body is arranged along the vertical axis between the first end and the second end. The second end is joined to the first side of the transverse body. The first end is located away from the second end. The vertical axis of the oblong body is offset from the center around the circle towards its anterior portion.

The anchor aperture through the base plate may be secured to the base plate so that the surgeon can advance the bone anchor through each anchor aperture without determining the angle or orientation of the anchor member during surgery. Remove the step of determining the angle or orientation.

The anchor aperture may be configured to allow the surgeon to select the angle of the anchor member with respect to the base plate or through the anchor aperture during surgery. Segmented screws can allow the angle of the anchor member through the anchor aperture to be selected during surgery. Angled internal members configured to tilt, rotate, or swivel can allow selection of the orientation of the anchor member with respect to the base plate during surgery.

In another embodiment, a glenoid base plate including a transverse plate and an anchor peg is provided. The transverse plate is formed between the medial side configured to engage the patient's scapula, the lateral side configured to face away from the medial side, and the medial and lateral sides. It has multiple bone screw holes and a circular perimeter. The circular perimeter extends between the medial and lateral sides. The circular perimeter has an anterior portion configured to be oriented towards the anterior side of the scapula, a posterior portion configured to be oriented towards the posterior side of the scapula, and a center. Anchor pegs are arranged along the vertical axis between the outer end coupled to the inner side of the traverse plate and the inner end located away from the outer end. The vertical axis of the anchor peg is offset from the center of the circular perimeter towards its anterior portion.

In another embodiment, the method by which the glenoid anchor is provided is performed or ordered. The glenoid anchor has a transverse member and a protrusion. The transverse member has an inner side, an outer side, a front perimeter, and a rear perimeter. The protrusion extends from the medial side. The protrusion is located closer to the anterior periphery than to the posterior periphery. In the method, blind holes are formed in the lateral part of the scapula. The blind hole is formed along a trajectory offset from the center of the lower portion of the glenoid fossa. The blind hole has an opening in the glenoid fossa and an enclosed end opposite to the opening. The closed ends are spaced from the anterior surface of the scapula. The closed ends are spaced from the posterior surface of the scapula. The protrusion of the glenoid anchor progresses into the blind so that the protrusion is closed in the scapula along the blind between the opening and the closed end.

In another embodiment, a method of receiving image data in response to a scan of the patient's scapula is performed. Anchor trajectories extending inward from the lateral surface of the scapula are identified from the image data. The anchor locus is located at a position selected with respect to the anterior surface of the scapula, for example, at a distance from the anterior surface of the scapula. The anchor locus may be at a position selected with respect to the posterior surface of the scapula, for example, at a distance from the posterior surface of the scapula. Spacing at least one of the anchor trajectories from the front surface or the anchor trajectories from the rear surface is based on imaging information. A glenoid anchor with traversing members and protrusions is formed. The glenoid anchor has a medial side, a perimeter bordering the medial side, a lateral side, an anterior part, and a posterior part. The protrusion extends from the medial side. The protrusion is placed within the perimeter at a position aligned with the identified anchor locus when the perimeter is aligned with the curvature of the lower portion of the glenoid edge.

In some cases, the perimeter that borders the medial collateral corresponds to the curvature of the part of the glenoid edge of the patient. For example, the perimeter may correspond to the lower portion of the patient's glenoid rim. The perimeter may correspond to the curvature of another part of the glenoid fossa if the lower part of the glenoid edge is affected by the deformation. The perimeter may, in some cases, be independent of the shape or curvature of the patient's rim.

In some embodiments, an approach is used in which perforation of some wall of the scapula just below the glenoid surface is desirable, for example to result in bicortical fixation of anchor pegs or other elongated members. This approach may be combined with an approach that selects a position for an anchor peg or other elongated anchor member that extends into a relatively deep portion of the area below the glenoid fossa (eg, the fornix).

The various embodiments are represented in the accompanying drawings for illustration purposes and should not be construed as limiting the scope of the embodiments. In addition, various features of different disclosed embodiments may be combined to form additional embodiments that are part of the present disclosure.

Showing a model of the scapula with the human humerus and glenoid, the glenoid has an indirect assembly attached to it, the indirect assembly having a glenoid base plate with a medial end protruding through the posterior wall of the scapula. Including, the humerus has a reverse implant assembly attached to it. It is a schematic diagram of a glenoid fossa and an imaging device that can be used to collect imaging information about the glenoid fossa. It is a flowchart of the method which can be executed by the image pickup information. It is a schematic diagram of a part of the scapula including the glenoid fossa. It is a flowchart of how to achieve both cortical fixations and a sufficient anchor peg length. It is a schematic diagram of a part of the scapula including the glenoid fossa. Two figures of the scapula with an indirect assembly base plate coupled to it are shown, the medial end of the base plate projecting through the posterior and anterior walls of the scapula. FIG. 3 is a side view of one embodiment of a glenoid base plate with anteriorly offset anchor pegs. It is a lateral side view of the glenoid base plate of FIG. It is a cross section of the glenoid base plate of FIG. FIG. 3 is a side view of another embodiment of a glenoid base plate with an anteriorly offset anchor peg. It is a lateral side view of the glenoid base plate of FIG. FIG. 3 is a side view of another embodiment of a glenoid base plate having an anteriorly offset anchor peg and a lateral mounting protrusion that tapers with a relatively short diameter. It is a lateral side view of the glenoid base plate of FIG. FIG. 5 is a cross section of the glenoid base plate of FIG. FIG. 3 is a side view of another embodiment of a glenoid base plate with a centralized anchor peg. FIG. 3 is a side view of another embodiment of a glenoid base plate having an anchor peg offset anteriorly to a position aligned with the aperture circumference. It is a lateral side view of the glenoid base plate of FIG. The various steps of how to attach the glenoid base plate to the scapula are shown. The various steps of how to attach the glenoid base plate to the scapula are shown. The various steps of how to attach the glenoid base plate to the scapula are shown. The various steps of how to attach the glenoid base plate to the scapula are shown.

The present application is directed to improving success in achieving a healthy junction between the glenoid assembly and the human scapula. These improvements are intended to enable greater success in shoulder arthroplasty surgery. Figures 1 and 2 show concerns that may arise in some shoulder treatment. FIG. 1 shows a schematic view of the humerus 50 and the scapula 55 of the shoulder with an inverted shoulder implant placed on the shoulder. The humerus 50 has a humerus excision portion 52. The humerus implant assembly 53 includes a humerus anchor (shown just below the humerus resection 52) and a reverse articular body 54. The reverse articular body 54 may, in some cases, be placed above the humerus resection 52, or at least partially below the humerus resection 52. The scapula 55 has a lateral surface 56 that includes a glenoid fossa 58 (see FIG. 1A). The glenoid fossa 58 is a part of the scapula 55 to which the tip of the humerus 50 is usually connected by a joint. Following total shoulder arthroplasty, this function is provided by the articular body 66 attached to the scapula 55. For example, a glenoid assembly 60 may be provided that includes a glenoid base plate 62 to support the articular body 66. The glenoid base plate 62 may be coupled to the scapula 55. The glenoid base plate 62 may have an anchor peg 64 configured to advance into the scapula 55. The glenoid base plate 62 may have an end located just below the glenoid fossa 58 and above the bone if the glenoid fossa 58 is punctured with a reamer. In some embodiments described below, the glenoid base plate 62 may be placed on the glenoid fossa 58 without reamer puncturing or with minimal reamer piercing.

In the suboptimal case, the glenoid base plate 62 is not properly placed on the scapula 55. FIGS. 1 and 2 show that the anchor peg 64 of the glenoid base plate 62 may be placed in the scapula 55 in a suboptimal manner in which the medial end of the anchor peg 64 penetrates the posterior surface 78 of the scapula 55. show. The anchor peg 64 may be exposed outside the scapula 55 in that case. FIG. 2 shows that the medial end of the anchor peg 64 can penetrate the anterior surface 76 or posterior surface 78 of the scapula 55. Those results are suboptimal for several reasons. The safety of the joint between the anchor peg 64 and the bone of the scapula 55 depends on the length of direct contact between those structures. Direct contact provides an opportunity for intraosseous growth and provides safety. Such endoculture does not occur along the fully exposed length. In addition, the exposed edges can cause irritation to the soft tissue around the scapula 55. Furthermore, if the anchor peg 64 pierces the bone at an undesired location, the piercing weakens the scapula and increases the risk of fracture.

FIG. 1A outlines the lateral side of the scapula 55. The glenoid fossa 58 includes a joint surface separated from the rest of the glenoid fossa by the glenoid rim 68. A healthy shoulder joint generally has an elongated articular surface within the glenoid rim 68 with a substantially circular inferior portion 70. More specifically, the inferior portion 70 may be surrounded by a circular segment of the glenoid edge 68. The circular portion of the glenoid edge 68 may be located around the center 72. More generally, the center 72 may be the central portion of the lower portion 70, eg, the geometric center. The center 72 extends from the top of the glenoid rim 68 (located at the top of the graphic in FIG. 1A) to the bottom of the glenoid rim 68 (located at the bottom of FIG. 1A). It may be located on the upper-lower axis of 68 or along the upper and lower axes. The center 72 is located at the central part of the chord extending across the glenoid edge 68, eg, at the midpoint, in the entire upper-lower part of the glenoid fossa 58 or below the geometric center of the glenoid edge 68. There is. For example, the center 72 may be located approximately one-half to two-thirds of the distance from the lowest point of the glenoid edge 68 to the entire glenoid fossa 58 or the geometric center of the glenoid fossa 68.

As discussed in more detail below, the imaging device 80 may be used to scan the scapula 55 and collect imaging information. The information may be processed in the image processing system 82. The image processing system 82 may include a memory capable of storing image pickup information corresponding to the scanned data from the image pickup apparatus 80. The image processing system 82 may also include one or more hardware processors capable of executing instructions. The image processing system 82 may process the imaging information to identify all the previously described structures of the scapula 55. The imaging information may also be processed to identify the anchor locus 84 in the direction into the scapula 55 for placing the anchor pegs. The anchor locus 84 may be oriented from a blind hole 220 (discussed below in connection with FIG. 7A) on the lateral surface 56 of the scapula 55. The blind hole 220 may extend along the anchor locus 84 from the opening 224 (schematically shown in FIG. 1A as the opening 86). The anchor locus 84 may be offset from the center 72 of the lower portion 74 of the glenoid fossa 58. As shown in FIG. 1A, the offset may be in the direction of the front surface 76. The opening 86 may be located between the center 72 and the front surface 76. The opening 86 may be located at 10% of the distance from the center 72 to the anterior side of the glenoid edge 68 adjacent to the anterior surface 76 of the scapula 55. The opening 86 may be located at 20% of the distance from the center 72 to the anterior side of the glenoid edge 68 adjacent to the anterior surface 76 of the scapula 55. The opening 86 may be located at 30% of the distance from the center 72 to the anterior side of the glenoid edge 68 adjacent to the anterior surface 76 of the scapula 55. The opening 86 may be located at 40% of the distance from the center 72 to the anterior side of the glenoid edge 68 adjacent to the anterior surface 76 of the scapula 55. The opening 86 may be located at 50% of the distance from the center 72 to the anterior side of the glenoid edge 68 adjacent to the anterior surface 76 of the scapula 55. The opening 86 may be located at 60% of the distance from the center 72 to the anterior side of the glenoid edge 68 adjacent to the anterior surface 76 of the scapula 55. In some cases, the opening 86 is located, for example, closer to the posterior surface 78 of the scapula 55 by either of those proportions or other proportions, in directions other than towards the anterior surface 76. The opening 86 may be in the other direction and, depending on the patient's needs, for example, in the downward, upward, or some direction between either anterior, posterior, downward, or upward. You may.

The image processing system 82 may be configured to process the imaging information in any suitable manner. FIG. 1B shows one method that can be performed, at least in part, by the image processing system 82. In step 88, the process may receive imaging information. For example, the imaging device 80 may be connected by a network to a computer having a processor configured to receive imaging information. The network may include an internet connection, a wireless connection, or a wired connection within the same facility in which the image pickup device 80 is located. In some applications, the data file containing the imaging information may be physically transported to the image processing computer. In some applications, the imaging device 80 is directly connected to a computer having a processor configured to process imaging information.

Then, in step 90, the lateral portion or lateral surface 56 of the scapula 55 may be characterized. The characterization of the lateral portion may include segmentation to generate a virtual model of all or part of the scapula 55. Step 90 may include forming a virtual model of all or part of the humerus 50. Step 90 may include forming a virtual model of all or part of the glenoid fossa 58. The virtual model formed in step 90 may include a model of the glenoid edge 68. The virtual model formed in step 90 may include a model of the lower portion 70 of the glenoid edge 68. In step 90, the center 72 of the lower portion 70 may be identified in virtual mode. The glenoid fossa 58 may be characterized to identify the center 72, for example by obtaining the radius of curvature of the inferior portion 70. The center 72 may be identified as the center for the radius of curvature of the lower portion 70.

Step 90 may include characterizing the lateral surface 56 of the scapula 55. The scapula 55 may be placed in the immediate vicinity of the glenoid fossa 58, for example, facing outward to the bone placed around the glenoid fossa 58. In some cases, the scapula 55 may be further characterized, for example, along the anterior surface 76 of the scapula 55 and / or along the posterior surface 78 of the scapula 55, inside the lateral surface 56. good. Step 90 may include determining the thickness of the scapula 55 between the anterior surface 76 and the posterior surface 78 at one or more positions of the glenoid fossa. For example, the thickness may be determined along line 91, as shown in FIGS. 1A and 1C. FIG. 1C provides a simplified illustration of line 91 as a straight line. In most examples of the glenoid fossa, the line 91 follows, for example, the curvature of the glenoid fossa 58 having a concave surface facing outward. The line 91 may extend from the anterior side of the glenoid rim 68 to the posterior side of the glenoid rim 68. The thickness t1 may be determined as a distance extending inward from the center 72. The distance may be measured at the center 72 perpendicular to the tangent to the glenoid fossa 58.

Step 90 may also include determining the thickness t2 at a position spaced from the center 72 if the thickness t1 is not sufficient to completely include the anchor peg 64 of the glenoid base plate 62. The position of the opening 86 may be determined as a position where the total of the thickness t2 and the thickness t3 exceeds the threshold value. In one method, it is preferable to provide a thickness t2 from the end of the blind hole 220, which can be formed to hold the anchor peg 64, to the outer wall of the rear surface 78. For example, the thickness t3 may be at least sufficiently large to leave the cortical wall in the posterior surface 78 intact. In one technique, the thickness t3 is measured from the portion of the blind hole 220 closest to the recent wall of the scapula 55. For example, if the posterior wall of the scapula 55 tilts anteriorly near the end of the blind hole 220, the measurement for t3 is from the posterior side of the blind hole 220 to the posterior wall (not from the center of the blind hole). be.

FIG. 1C shows that, in some cases, the scapula 55 may have a shape that allows the opening 86 to be placed over a range of locations. The distance from the positions of the measured thicknesses t2 and t3 to the measured position of the thickness t4 from the anterior surface 76 of the scapula 55 provides a range of possible positions for the opening 86. Once a range of positions has been identified for the opening 86, the choice of position for the opening 86 may be based on other factors such as bone quality under the glenoid fossa 58 along the range of positions shown in FIG. 1C. .. In some methods, the presence and location of any variant may be considered. For example, the presence and location of the deformity can affect the ability of the perimeter screw to be anchored to the bone. Thus, the position of the opening 86 may be adjusted or selected to provide the best overall anchor fixation, including those provided by peripheral screws.

The image processing system 82 may perform step 92 in which the position of the opening 86 and the anchor locus 84 are determined. The image processing system 82 may determine the dimensions t2 and t3 as part of determining the position of the opening 86 and the anchor locus 84. For example, the hardware processor in the image processing system 82 may execute code that implements a method of determining the thicknesses t2 and t3 for a given position offset from the center 72. The image processing system 82 may determine the dimension t3 at a position where the distance is increased forward from the center 72. The thickness t3 can provide an anatomical reference distance, such as the thickness of the cortical wall adjacent to the anterior or posterior wall of the scapula just below the glenoid fossa (see FIG. 1C). The thickness t2 may be determined by the image processing system 82 from the glenoid surface and the thickness t3 (see FIG. 1C). If the thicknesses t2 and t3 are sufficient for a given patient, the position with respect to the opening 86 may be established with the anchor locus 84. If either the thickness t2 or t3 is not sufficient, further increments from the center 72 may be evaluated by the image processing system 82. This further increment, eg, the condition in the bone corresponding to the thicknesses t2 and t3, may be evaluated by the image processing system 82 to determine if the thicknesses t2 and t3 are sufficient. In some embodiments, the image processing system 82 performs an additional step in the method of FIG. 1B to generate, for example, a configuration for the glenoid base plate 62. The configuration of the glenoid base plate 62 may include the amount of offset between the center of the proximal or distal (or transverse or medial) portion of the glenoid base plate 62 and the location of the center of the anchor peg 64. Overall, the direction in which the anchor peg 64 extends along it may be perpendicular to the lateral or medial surface of the glenoid base plate 62 in some embodiments. In some methods, the image processing system 82 comprises the position of the opening 86 and the corresponding position of the anchor peg 64, as well as the corresponding configuration of the anchor locus 84 and the anchor peg 64 within the scapula 55 (eg, orientation and length). ) Is determined, step 92 is terminated. The opening 86 is advantageous, as needed, in front of the center 72, behind the center 72, below the center 72, above the center 72, or in front of the center 72, based on the analysis in step 90. , Rear, downward, and upward may be determined to be located in any combination.

1 and 1C show that the direction of the opening 86 with respect to the center 72 is toward the front surface 76. The opening 86 may be located between the center 72 and the rear surface 78, as shown in FIG. If the rear surface 78 extends more generally inward-outward and the anterior surface 76 is more curved towards the rear surface (as shown in the lower figure of FIG. 2), then between the center 72 and the rear surface 78. A range of positions about the opening 86 may also be provided.

In step 94, specifications or configurations for the glenoid base plate 62 may be output. The output may be in the form of a line drawing. The output may be computer code that will be used by rapid manufacturing equipment. The output in step 94 may be transmitted directly or indirectly to multiple recipients, including review recipients, manufacturing recipients, physician customers, and / or patient customers.

In step 96, the output of the configuration or specifications of step 94 may be received by the manufacturing equipment. The configuration or specification may be received by another party in step 96. Step 96 may involve any type of 3D printer receiving the instructions output in step 94. The instructions may be received and implemented by a 3D printer forming the glenoid base plate 62 in step 98. Step 98 creates the glenoid base plate 62 by forming the glenoid base plate 62 and then passing the glenoid base plate 62 through an appropriate finishing step. Step 98 may include transferring the glenoid base plate 62 to the surgeon as soon as or after the method of FIG. 1B is completed.

1D-1E show further modifications of the methods and devices herein. The method shown in FIG. 1D is similar to the method of FIG. 1B, except that there is an additional step 93 in which the length of the slender body, eg, the anchor peg, is confirmed, which can be described as the anchor length. .. The anchor length may correspond to the thickness t4 between the glenoid surfaces. In one technique, determining the thickness t4 may include using an image processing system 82 to identify the cortical boundary 79, eg, the location of the overall cancellous bone transition to the overall cortical bone. good. The thickness t4 may be required to be at least the distance from the glenoid surface to the cortical boundary 79. The result is that the glenoid base plate formed by the oblong body defined by the method of FIG. 1D reaches the scapular wall and, in some cases, extends through the scapular wall, resulting in bicortical fixation. As such, the thickness t4 may be required to be greater than this distance. The rest of the method of FIG. 1D may be the same as the method of FIG. 1B.

The patent application filed under Agent Reference No. 126-033USP1 on May 13, 2019, which fills in the Inventor Pierric Deransart and Vincent Simoes and retains the title Patient-Matched Orthopedic Implant, is a patient-specific method. Or for further disclosure of various methods associated with constructing and creating various embodiments of articular base plates and other orthopedic implants in a patient-appropriate manner, as well as such articular base plates and orthopedic surgery. Incorporated below by reference in its entirety for further disclosure for all other purposes along with the implant.

3-3B show an exemplary glenoid base plate 100 according to one embodiment. As discussed below, the glenoid base plate 100 may be used to secure the glenoid joint member to the glenoid. The glenoid base plate 100 is an example of an embodiment of the glenoid base plate 62 discussed below.

The glenoid base plate 100 includes a transverse body 104 and an elongated body 108. The slender body 108 may be configured as, for example, an anchor peg similar to the anchor peg 64. The glenoid base plate 100 includes a first side portion 120. The first side portion 120 may be the medial side portion configured to engage the patient's scapula. The glenoid base plate 100 includes a second side portion 124. The second side portion 124 may be an outer side portion configured to face away from the inner side portion 120. The second side portion 124 may face away from the scapula 55 when the first side portion 120 is fixed against the scapula 55.

In FIG. 3A, the glenoid base plate 100 may include a plurality of anchor apertures 132, the plurality of anchor apertures 132 being a plurality of bone screw holes formed between the medial side 120 and the lateral side 124. Indicates that it may be. The anchor aperture 132 may, in some embodiments, be evenly distributed around the transverse body. In some embodiments, there is an uneven dispersion of anchor aperture 132 around the second side portion 124. The anchor aperture 132 may be a fixed hole or a fixed passage through the base plate 100. Anchor apertures may be formed as holes or passages partially defined by or through internal members placed within a recess in the base plate 100. In some embodiments, the recess and / or aperture 132 in the base plate 100 may include a non-threaded surface and / or a threaded surface. In various embodiments, one or more of the two or more apertures 132 may be threaded and another one or more of the two or more apertures 132s may be unthreaded. May be good. In an embodiment, the two threaded apertures 132 may be arranged through an extension of a first side or medial side 120, eg, an angled surface thereof, of one or more, eg, two. The non-threaded hole may be arranged adjacent to the threaded hole. The extension may be a predefined extension suitable for the patient, or a patient-specific extension specifically designed for the patient based on imaging of the patient's scapula and / or glenoid region. There may be. In some embodiments, the internal member (s) may include a hemispherical outer surface, which is hemispherical to allow movement of the internal member with respect to the base plate 100, such as rotation, tilting, and / or rotation. It may be placed in a recess that is. Internal members (s) allow the orientation of the bone anchor with respect to the base plate 100 to be selected during surgery. Further details of the internal members capable of rotating, tilting, or turning are described in US9629725B2, which is incorporated herein by reference.

The glenoid base plate 100 may have a circular perimeter 136 that can extend between the medial side 120 and the lateral side 124. The circular perimeter 136 may, for example, taper significantly towards the first side portion 120 rather than towards the second side portion 124. Circular perimeter 136 may correspond to the curvature of the lower portion 74 of the glenoid edge 68 of the scapula 55. The slender body 108 may be placed within the circular perimeter 136 at a position that would be aligned with the anchor locus 84 when the perimeter is aligned with the curvature of the lower portion 74 of the glenoid edge 68. The slender body 108 may be aligned with the opening 86 by rotating and orienting the glenoid base plate 100, for example, by orienting a directional mark such that it is oriented. Notations such as "SUP" may be marked for the transverse body 104 that will be aligned with the upward direction. In other embodiments, other markings of directionality may be provided.

FIG. 3A shows that the circular perimeter 136 of the glenoid base plate 100 may have a center 148 with a mechanism for fixing the articular body to the glenoid base plate 100, as further discussed below. The circular perimeter 136 may have an anterior perimeter 137 including a portion of the circular perimeter 136. The circular perimeter 136 may have a rear perimeter 138. The posterior perimeter 138 includes the posterior portion of the circular perimeter 136. The elongated body 108 may be configured as a protrusion extending from the medial side portion 120. The protrusion 108 may be located closer to the front circumference 137 than to the rear circumference 138.

The glenoid base plate 100 may include an anterior portion 140 configured to be oriented towards the anterior lateral portion of the scapula 55. The glenoid base plate 100 may include a posterior portion 144 configured to be oriented towards the posterior side of the scapula 55. The front portion 140 and the rear portion 144 may be arranged around the center 148, and may surround the center 148, for example.

FIG. 3 shows how the transverse body 104 and the elongated body 108 can be fixed or coupled to each other. The slender body 108 may extend along the vertical axis 160. The slender body 108 may have a first end 164 and a second end 168. The second end 168 may be coupled (eg, to the medial side) with the first side 120 of the transverse body 104. The first end 164 may be located away from the second end 168 (eg, away from the outer end). The first end 164 may be the medial end 164 of the glenoid base plate 100. The vertical axis 160 of the anchor peg 108 is offset from the center 148 of the circular circumference 136 towards the front portion 140. The center 148 is indicated by a dashed line in FIG. 3A and 3B show that the recess is formed at the center 148. The recess allows a joining mechanism (eg, a screw) to be used to secure the articular body (eg, articular body 66) to the glenoid base plate 100. The configuration of the glenoid base plate 100 allows the junction between the articular body 66 and the glenoid base plate 100 to be along the center 148 and, for example, the position of the elongated body 108 from the center 148 according to the method of FIG. 1B. Allows you to be spaced.

3A and 3B show that the glenoid base plate 100 may have a threaded hole 180 to facilitate the attachment of the articular body (eg, the articular body 66) to the glenoid fossa base plate 100. The threaded hole 180 is preferably configured as a blind hole with an open end 184. The blind hole configuration may include a closed end 188. The closed end 188 significantly increases the strength of the glenoid base plate 100 compared to where the threaded hole 180 opens on the medial side of the structure. The screw hole 180 may be formed in the fastener body 192. The fastener body 192 may be configured as a transverse extension of the elongated body 108, as most prominently seen in FIG. The fastener body 192 may have a width shorter than the diameter of the slender body 108 at its first end 164. The fastener body 192 may extend a distance shorter than the inner-outer thickness of the transverse body 104. The fastener body 192 may include a first end 194 and a second end 196. The second end 196 may be coupled to the first side portion 120 of the transverse body 104. The first end 194 may be disposed away from the transverse body 104. The fastener body 192 allows the fasteners to be extended for at least a short distance above the transverse body 104. This configuration allows the transverse body 104 to be relatively or perfectly flat on the second side portion 124.

The circular perimeter 136 of the transverse body 104 includes a tapered contour 201 configured to coincide with the tapered recess of the articular body 66. The second side portion 124 of the glenoid base plate 100 may have an aperture circumference 204 in which the anchor aperture 132 is evenly distributed around the outer surface of the transverse body 104. FIG. 4A shows an embodiment in which all of the anchor apertures 132 are evenly spaced around the outer surface of the transverse body 104. FIG. 3A shows that the anterior portion of the aperture circumference 204 opposite to the elongated body is formed without an aperture, resulting in, for example, a continuous region 205. The continuous region 205 may include solid surfaces at regular intervals from adjacent anchor apertures 132. The presence of the continuous region 205 may result from shifting the position of the oblong body 108 within the region of the anchor aperture 132. Because the oblong body 108 is solid there, there is no opportunity to orient the bone screw through that region. Therefore, the continuous region 205 may be provided. The continuous region 205 may be a solid region or a non-perforated region.

In some embodiments, the inner junction 208 is provided at the first end 164 of the oblong body 108. The inner junction 208 may include a blind hole centered on the distal surface of the oblong body 108. The medial junction 208 may be used to secure the patient's bone or graft material. The blind hole allows the pin or peg to be inserted into the oblong body 108 while manipulating or processing the glenoid base plate 100. During such retention, the glenoid base plate 100 may be further processed to provide a suitable smoothed surface. The operational junction 208 is optional and may be replaced with a solid surface at the second end 168 of the oblong body 108.

The operation of the glenoid base plate 100 may be facilitated by providing the tool joint 150 on the transverse body 104, eg, on its second side portion 124. As discussed above, the second side portion 124 may be the lateral side portion of the glenoid base plate 100. The second side 124 is accessible by a tool that can be extended to the surgeon in use through the skin when the tool was used to pass the glenoid base plate 100 through the skin towards the glenoid. You may. The tool joint 150 may include two or more opposed slots, openings, or blind holes in the second side portion 124 of the transverse body 104. Slots, openings, or blind holes may be angled toward each other so that their ends are closer to each other on the surface of the second side portion 124 than the ends of the slots, openings, or blind holes. As shown, the tool joint 150 may be located just outside the aperture circumference 204 between two adjacent anchor apertures 132 around it.

4 and 4A show a glenoid base plate 100A similar to the glenoid base plate 100, except as described differently below. The description of the glenoid base plate 100 complements the description of the glenoid base plate 100A. Any mechanism of the Glenoid Base Plate 100A comparable to the Glenoid Base Plate 100 also complements the Glenoid Base Plate 100. The glenoid base plate 100A includes a transverse body 104 and an elongated body 108 as discussed above. The elongated body 108 extends along the vertical axis 160. The transverse body 104 may have a circular perimeter 136 with a center 148. An offset may be provided between the center 148 and the oblong body 108. The offset may be forward as shown in FIG. Depending on the nature of the scapula to which the glenoid base plate 100A will be applied, the offset between the elongated body 108 and the center 148 may be in another direction, eg, posterior. The offset between the oblong body 108 and the center 148 can be in any other direction, eg, downward, upward, or anterior, posterior, downward, or upward, depending on the patient's needs. May be in any direction.

The glenoid base plate 100 may have a fastener body 192A placed parallel to the elongated body 108. The fastener body 192A may be similar to the fastener body 192. For example, the fastener body 192A may have a closed end 188 and an open end 184. The fastener body 192 may have a threaded hole 180 extending from the open end 184 to the closed end 188. The fastener body 192A may also be provided to allow at least a portion of the fasteners attached to the glenoid base plate 100A to be placed beneath the surface of the bone to which the first side portion 120 is attached. good. The fasteners attached to the fastener body 192A may extend outward from the open end 184 and into the joint body to further secure the reverse joint body 66 to the glenoid base plate 100A. Therefore, a portion of the fastener may be placed in a portion of the reverse joint body 66, a portion of the thickness of the transverse body 104, and a portion of the fastener body 192A.

The fastener body 192A extends away from the sides of the elongated body 108 to a lesser extent than the fastener body 192 in the glenoid base plate 100 does. Placing the glenoid base plate 100A does not require much bone preparation of the glenoid 58 to accommodate a smaller volume of the fassna body 192A compared to the fassa body 192. Also, the position of the slender body 108 closer to the fastener body 192A allows the perimeter of the slender body 108 to be placed inward in the anchor aperture 132 in the transverse body 104. FIG. 4A shows that the configuration allows the aperture circumference 204 to include anchor apertures 132 that are evenly distributed around the transverse body 104. For example, the transverse body 104 may have, for example, an anchor aperture 132 located between the position of the elongated body 108 on the vertical axis 160 and the front portion 140 of the circular circumference 136. The glenoid base plate 100A advantageously allows the elongated body 108 to be completely packed into the bone inside the first lateral portion 120 of the transverse body 104 and also provides further fixation to the scapula. Allows anchors to be placed through the anchor aperture 132 in a uniform distribution.

5-5B show the glenoid base plate 100 and the glenoid base plate 100B similar to the glenoid base plate 100A, except as described differently below. The description of the glenoid base plate 100 and the glenoid base plate 100A complements the description of the glenoid base plate 100B. A description of either the mechanism of the glenoid base plate 100 or the mechanism of the glenoid base plate 100B comparable to the glenoid base plate 100A also complements the description of the glenoid base plate 100 and / or the glenoid base plate 100A.

The glenoid base plate 100B includes an elongated body 108B and a transverse body 104B. The slender body 108B is arranged along the vertical axis 160. The transverse body 104B is symmetrical about the center 148, which is shown as the center axis 148. The glenoid base plate 100B includes a coupling protrusion 210 located on the side of the transverse body 104B opposite to the elongated body 108B. The coupling protrusion 210 may be symmetrical around the center 148. The coupling protrusion 210 may have a tapered outer circumference. The coupling protrusion 210 may have an outer circumference that decreases in diameter along its length from the transverse body 104B to the free end of the coupling protrusion 210. The coupling protrusion 210 may include a threaded hole 180B formed therein to engage with the articulated body 66. The threaded hole 180B may be arranged between the open end 184B and the closed end 188B within the coupling protrusion 210. The closed end 188B may be disposed within the thickness of the transverse body 104B. The closed end 188B may be disposed between the elongated body 108B and the coupling protrusion 210. The tool joint 212 may be arranged in the threaded hole 180B. The tool joint 212 may extend from the open end 184B toward the closed end 188B.

The tool joint 212 may be rotationally asymmetric to help visualize or bring about the correct orientation of the glenoid base plate 100B with respect to the scapula. For example, an array of concave surfaces may be provided around the tool joint 212. An enlarged concave surface may be provided above the tool joint 212. For example, directional vision labeled "SUP" for the upper side of the outer side of the transverse body 104B and / or "INF" for the lower side of the outer side of the transverse body 104B. Marks may also be provided on the glenoid base plate 100B. In other embodiments, the transverse body 104B may be labeled "ANT" for the anterior or "POS" for the posterior. Other markings may be used to indicate one or more of those orientations.

The transverse body 104B may include an anchor aperture 132B similar to the anchor aperture 132, or may include a bone anchor that can proceed through it, for example, a screw for joining the transverse body 104B to a screw. The screw may be segmented to allow the screw to be secured to the bone anchor in a fixed orientation, which allows the orientation to be selected during surgery.

One advantage of the configuration of the glenoid base plate 100B is that the slender body 108B is a second (of the slender body 108B from the first end located on the side or medial side facing the first bone of the transverse body 104B. It may have a cylindrical shape with a circular contour to the inner) end. The outer surface of the slender body 108B is the fastener body 192 or because the fasteners advancing into the threaded hole 180B do not extend beyond the side or medial side of the transverse body 104B facing the first bone. It is free from the same structure as the fastener body 192A. This allows for easier preparation of the patient's scapula in that a circular hole can be formed in the recess that allows the glenoid base plate 100B to be more easily inserted into the bone. To. The presence of Fasna Body 192 or Fasna Body 192A during the fit of the Glenoid Base Plate 100 or the Glenoid Base Plate 100A if the base plate is adjusted without the patient-specific medial aspect configured to be placed on the glenoid fossa. It may require either complementary preparation of bone or compression of bone. In cases where the inner surface is made patient-specific, the fastener body 192 or fastener body 192A may be located on the medial side of the base plate in a spread of the base plate that extends to the patient and when added. It may be located outside the glenoid surface. Therefore, no additional bone preparation is required for Fastener 192 or Fastener 192A.

The articulating process 210 can provide the articular body 66 with a joint similar to that provided by the tapered contour 201 of the glenoid base plate 100 or the glenoid base plate 100A. The coupling projection 210 has a tapered contour with larger dimensions towards the transverse body 104B adjacent to the free end of the coupling projection 210. The maximum dimension of the coupling protrusion 210 is smaller than the dimension of the side portion of the transverse body 104B to which the coupling protrusion 210 is bonded. Therefore, the coupling protrusion 210 may be smaller than the transverse body 104B. The coupling protrusion 210 may have an aspect ratio (height relative to the diameter of the protrusion 210) greater than 1: 5. In various embodiments, the coupling projection 210 has an aspect ratio of greater than 1: 4, greater than 1: 3, greater than 1: 2, eg, about 1: 1. In contrast, the transverse body 104 may have an aspect ratio less than 1: 1 (diameter relative to the height of the body 104), which provides a tapered contour 201 around which it matches the joint body 66. good. The transverse body 104 may have an aspect ratio of less than 1: 2, less than 1: 3, and less than 1: 4. In some embodiments, the transverse body 104 has an aspect ratio between 1: 2 and 1: 7, eg, about 1: 5. Insertion and alignment of the joint body 66 with the smaller coupling protrusion 210 can be easier than insertion and alignment of the joint body 66 with respect to the overall larger tapered contour 201. Aligning the body 66 to the smaller diameter protrusion 210 is easier, in part due to the higher aspect ratio (length vs. width) of this mechanism. That is, the protrusion 210 has a much higher aspect ratio than the tapered contour 201, which is narrower and longer, and thus shorter and wider. The higher aspect ratio allows the joint 66 to be placed on the free end of the coupling protrusion 210, and as it progresses to the transverse body 104B, the protrusion 210 is in the proper position prior to complete joining. Guide the main body 66 during alignment. In the case of the tapered contour 201, the smaller aspect ratios cause less alignment confirmation due to the structure of their mechanism before the parts are completely joined. Alignment is just more difficult due to the presence of soft tissue and limited visibility. However, both junctions provide an excellent junction between the articular body 66 and the corresponding glenoid base plate.

FIG. 5C shows a glenoid base plate 100C similar to the glenoid base plate 100B, except as described differently below. The glenoid base plate 100C also has similarities to some mechanisms of the glenoid base plate 100 and the glenoid base plate 100A. The description of the glenoid base plates 100, 100A, 100B complements the description of the glenoid base plate 100C. A description of any of the mechanisms of the Glenoid Base Plate 100C comparable to the Glenoid Base Plates 100, 100A, 100B also complements the description of the Glenoid Base Plates 100, 100A, and / or the Glenoid Base Plate 100B.

FIG. 5C shows that the glenoid base plate 100C has an elongated body 108C disposed on the medial side of the transverse body 104B. The transverse body 104B is placed on the center 148 as it is on the glenoid base plate 100B. The slender body 108C is arranged along the vertical axis 160. The vertical axis 160 is aligned with the center 148 of the transverse body 104B and, for example, intersects the center 148 of the transverse body 104B or is collinear with the center 148 of the transverse body 104B. Thus, the glenoid base plate 100C provides a configuration in which both the coupling process 210 and the elongated body 108C are symmetrical about a common axis. The glenoid base plate 100C is suitable for patients with more symmetrical anterior and posterior surfaces 76 and / or patients with a thicker scapula. Those patients have the anchor locus 84 along the plane perpendicular to the plane of the transverse body 104B extending away from the first side portion 120 of the transverse body 104B when the anchor locus 84 is aligned with the center 72 of the glenoid fossa 58. It can receive the full length of the elongated body 108C.

The configuration of FIG. 5C may include a coupling protrusion 210 and a tool joint 212. The glenoid base plate 100 may be formed in the same symmetrical configuration as the glenoid base plate 100C.

FIG. 6 shows a glenoid base plate 100D similar to the glenoid base plates 100, 100B, except as described differently below. The glenoid base plate 100D also has similarities to some mechanisms of the glenoid base plates 100A, 100C. The description of the glenoid base plates 100, 100A, 100B, 100C complements the description of the glenoid base plate 100D. The description of any of the mechanisms of the glenoid base plate 100 and / or the glenoid base plate 100, 100A, 100B, 100C comparable to the glenoid base plates 100, 100A, 100B, 100C also complements the description of the glenoid base plate 100 and / or the glenoid base plates 100, 100A, 100B, 100C.

The glenoid base plate 100D has a transverse body 104B and an elongated body 108D. The slender body 108D is the same as the slender body 108B. The slender body 108D extends from the first side portion 120 of the transverse body 104B to a free end located away from the first side portion 120. The elongated body 108D extends along the vertical axis 160. The vertical axis 160 may be offset from the center 148 of the coupling projection 210 arranged on the side of the transverse body 104B opposite to the elongated body 108D. The offset between the center 148 and the vertical axis 160 may be forward. Such offsets are suitable for patients in which more bone stock is available towards the anterior surface 76 than towards the posterior surface 78 of the scapula 55.

The offset between the vertical axis 160 of the glenoid base plate 100D or the glenoid base plate 100 and the center 148 may be about 6 mm in one embodiment. The offset between the vertical axis 160 and the center 148 of the glenoid base plate 100D or the glenoid base plate 100 may be about 5 mm in one embodiment. The offset between the vertical axis 160 and the center 148 of the glenoid base plate 100D or the glenoid base plate 100 may be about 4 mm in one embodiment. The offset between the vertical axis 160 and the center 148 of the glenoid base plate 100B or the glenoid base plate 100A may be about 3 mm in one embodiment. The offset between the vertical axis 160 of the glenoid base plate 100B or the glenoid base plate 100A and the center 148 may be about 2 mm in one embodiment. The offset between the vertical axis 160 of the glenoid base plate 100B or the glenoid base plate 100A and the center 148 may be about 1 mm in one embodiment. The offset between the vertical axis 160 and the center 148 of the glenoid base plate 100B or the glenoid base plate 100A may be about 0.5 mm in one embodiment.

FIG. 6A shows that the glenoid base plate 100D omits one or more anchor apertures 132 for some amount of offset. As in the glenoid base plate 100, the aperture circumference 204 results in the anchor aperture 132B being evenly distributed around the second side portion 124 of the transverse body 104B. The anchor apertures 132B may be spaced by even increments. At one or more of the incremental positions, the transverse body 104B is solidified without the anchor aperture 132B formed therein. The anchor aperture 132B is omitted because the glenoid base plate 100D has an elongated body 108D that is at least partially located within the region of the omitted anchor aperture 132B. Bone anchors such as bone screws cannot be placed through this area because the oblong body 108D is positioned in this position.

Shoulder implants composed of surgical plans The various glenoid base plates discussed above can be better understood with reference to FIGS. 1A-1C. The glenoid base plate 100 may advantageously be formed following step 88 in which imaging information of the scapula 55 is acquired from the imaging device 80. The imaging device 80 may be a CT scanner, X-ray, MRI, or other similar imaging modality, or from a tracer capable of acquiring the bone shape by direct contact with the bone or tissue above the bone. There may be. The scapula 55 may be characterized in step 90. This is to generate a virtual model of the scapula 55, for example, by segmenting the imaging information to provide a 3D model that can be stored in memory and / or displayed in a graphical user interface. It may be accompanied by any suitable technique adopted by the image processing system 82 of. This information may include identifying the center 72 of the lower portion 70 of the glenoid fossa 58. The center 72 may be identified as the midpoint of the chord of the lower portion 74 of the glenoid edge 68 of the scapula 55. The chord may be located at a distance equal to the radius from the rearmost point of the lower portion 74 of the glenoid edge 68. The chord is located in an upper-lower position along the glenoid edge 68 between its anterior portion adjacent to the anterior surface 76 of the scapula 55 and its posterior portion adjacent to the posterior surface 78 of the scapula 55. May be good. The upper-lower position may be such that the distance across the glenoid 58 is equal to twice the radius of curvature of the lower portion 74 of the glenoid edge 68. The glenoid base plate 100 may be configured such that the transverse body 104 has a circular circumference having a radius equal to the radius of curvature of the lower portion 74 of the glenoid edge 68. The center 148 of the transverse body 104 may be located at the center 72 as determined in step 90.

The position of the slender body 108 may be determined in step 92. The step involves finding a suitable location to prepare the opening 86 on the surface of the glenoid fossa 58 to receive the slender body 108. As mentioned above, the position may be positioned adjacent to the center 72. The opening 86 is advantageously anterior to the center 72, posterior to the central 72, above the center 72, below the center 72, or anterior or posterior to the center 72, depending on the needs based on the analysis in step 90. , Upper, and lower, may be formed in any combination. The location of the opening 86 is by finding a location along line 91 where any combination of depth, strength, thickness, bone density, and bone strength is sufficient to fit the minimum length of the oblong body 108. It may be selected. The location of the opening 86 may be one in which the bone supports the formation of a blind hole in the scapula 55 extending from the opening 86 to the closed end, where the overall length of the oblong body 108 at the blind hole. Can be adapted to. With reference to FIG. 1C, the slender body 108 may have a length equal to the thickness t2. The position may be any position between the two horizontal lines bordering reference numeral 86.

Step 94 may include specifying the diameter of the transverse body 104 and the position of the oblong body 108. Step 94 may also include specifying the length of the oblong body 108. For patients with a larger bone volume in the scapula 55, the elongated body 108 is created longer than the minimum length if the additional length is considered to provide clinical benefits, eg, better implant safety. May be done. Step 94 also extends below the bone surface (as shown in FIGS. 3-4A) or is threaded outside the bone (as shown in FIGS. 5-6A) when applied to the patient. A base plate with holes may be output.

Step 98 may include forming the base plate through an adhesive manufacturing process, eg, a suitable process such as three-dimensional printing. Examples of three-dimensional printing include direct metal laser sintering (DMLS), Fused Deposition Modeling (FDM), Fused Deposition Modeling (FFF), and electron beam melting (EBM). Any one or combination of those adhesive manufacturing steps or other adhesive manufacturing steps may be used in step 98. In those steps, a three-dimensional object is formed by continuously forming individual layers of the object on top of the previously formed individual layers. These steps can tightly control the total dimensions of the object and can form complex features and shapes such as curves. In certain embodiments, as shown by the dashed-dotted line 99 in FIG. 1, a complementary surface capable of matching a particular biological structure of a particular patient, eg, having a convex curved surface that coincides with the concave curved surface of the glenoid fossa 58. Step 98 may be used to form the first side portion 120 of any of the glenoid base plates disclosed herein as.

As further discussed above, the scapula 55 has a thickness between the anterior surface 76 and the posterior surface 78, and the scapula may be small, rapidly and / or predicted beneath the glenoid fossa 58. It may decrease unreasonably. Changes in thickness beneath the glenoid fossa 58 may be due to a number of factors, including irregular or inconsistent anterior and posterior surfaces of the scapula from patient to patient. The methods and devices described above result in consistently sound anchoring of the elongated protrusions of the glenoid base plate onto the medial collateral ligament of the base plate within the wall of the scapula. Applicants of this application have found for many patients that this results in an offset inner post where the post is offset to the anterior area of the base plate. Their composition can lead to a higher likelihood of clinical success.

Surgical Methods for Base Plates Constructed Based on the Patient's Scapular Biological Structure The aforementioned disclosures provide a variety of advantageous surgical methods. 7-7C show some of those methods. FIG. 7 shows, for example, that a blind hole 220 can be formed in the lateral surface 56 of the scapula 55 within the surface of the glenoid fossa 58. The blind hole may be formed at the position of the opening 86 identified in the methods of FIGS. 1A-1C. The blind hole may extend from the opening 224 corresponding to the opening 86 to the closed end 228 opposite to the opening 224. The closed end 228 may be at a depth and anterior-posterior position spaced from the anterior and posterior surfaces 78 of the scapula 55. The blind hole may extend along the axis corresponding to the anchor locus 84 determined in the methods of FIGS. 1A-1C. 7 and 7A show that the blind hole 220 is offset from the center 72 of the lower portion 70 of the glenoid fossa 58.

FIG. 7 shows that the blind hole 220 may be enlarged for some of the base plate configurations, for example to provide an expanded opening 226. The expanded opening 226 may be a portion extending from the blind hole 220 toward the center 72. For example, the glenoid base plate 100A contains a fastener body 192A aligned with the center 148. The center 148 will be aligned with the center 72 when the glenoid base plate 100A is added. Therefore, the surface of the glenoid fossa 58 may be prepared to accommodate the fastener body 192A by enlarging the blind hole 220 including the dilated opening 226. The dilated opening 226 is at the center 72, above the center 72, or at the center 72 so that the screw for joining the joint body 66 to the glenoid base plate 100A can be centered on the transverse body 104. Placed around. Forming the dilated opening 226 may be accomplished by a surgical drill, by a small reamer, by a tamp, or in the process of placing a trial implant in the glenoid fossa 58. Alternatively, the glenoid base plate 100A may proceed into the blind hole 220, and the dilated opening 226 may be formed by bone compression as the glenoid base plate 100A is fitted into the bone. good.

FIG. 7C shows the addition of the Glenoid Base Plate 100D to the Glenoid 58. The slender body 108D may proceed as indicated by the arrow 240 towards the glenoid fossa 58, such that the slender body 108D is at the opening 224 to the blind hole 220. The slender body 108D may travel into the blind hole 220 until the slender body 108D is adjacent to or in contact with the closed end 228. The slender body 108D may proceed into the blind hole 220 until the slender body traverse body 104B is adjacent to or in contact with the glenoid fossa 58. The slender body 108D is in contact with or nested until the patient-matched medial side of the glenoid fossa base plate 100D as indicated by the dashed line 99 in FIG. 1 is in contact with or nested in the natural or existing concave surface of the glenoid fossa 58. It may proceed into the blind hole 220. The slender body 108D is located adjacent to or in contact with the closed end 228.

Prior to advancing the elongated body 108D into the opening 224, the glenoid base plate 100D may be rotated and oriented with respect to the glenoid 58 as indicated by arrow 241. For example, if there are rotational positioning marks or mechanisms, those mechanisms may be appropriately oriented by the surgeon. As mentioned above, the second side portion 124 of the transverse body 104B may be marked by "SUP" to indicate the portion of the transverse body 104B that should be oriented upwards. Instead of relying on marking "SUP" for the top, "INF" for the bottom, "ANT" for the front, "POS" for the back, etc. in some embodiments. On or in addition, on the coupling projection 210 of the transverse body 104B so that it can be easily visually confirmed that the portion of the instrument that advances or holds the glenoid base plate 100D is properly oriented. The arranged tool joint 212 may be rotationally asymmetric.

FIG. 7C shows that the glenoid base plate 100D may be anchored to the scapula 55 following rotational positioning (if required) and progression of the glenoid base plate 100D into the blind hole 220. One or more bone anchors 244 may travel through the transverse body 104B and into the bone. The bone anchor 244 may be directed towards and / or into the cortical bone of the scapula 55 through the transverse body 104B. In some techniques, the orientation of the bone anchor 244 or its length may be planned or selected before or during surgery to ensure specific results. For example, the orientation or length indicates that the end of the bone anchor 244 opposite to the end attached to the transverse body 104B is placed in the cortical bone, but not through the anterior surface 76 or posterior surface 78 of the scapula 55. It may be planned or selected to guarantee. The orientation or length indicates that the end of the bone anchor 244 opposite to the end attached to the transverse body 104B is placed in the cortical bone and also extends through the anterior surface 76 or posterior surface 78 of the scapula 55. It may be planned or selected to guarantee. FIG. 7C shows only one screw placed in the scapula 55 through the transverse body 104B. For example, additional screws may be placed outside the fracture plane shown above and / or below the coupling protrusion 210. As discussed above, the glenoid base plate 100D is configured such that two anchor apertures 132B are provided in the upper and lower positions and one anchor aperture 132B is provided in the posterior position. An extension in front of the transverse body 104B is provided, omitting the anchor aperture 132B. FIG. 7C shows that the glenoid base plate 100D is anchored without any bone anchor 244 between the position of the elongated body 108D and the anterior perimeter of the transverse body 104B.

FIG. 7C shows that the articulated body 66 may be coupled to the glenoid base plate 100D following immobilization of the glenoid base plate 100D to the scapula 55. The articular body 66 may proceed as indicated by the arrow 252 towards the articulating process 210. The coupling projection 210 may be received in the corresponding tapered recess formed in the medial side of the articular body 66. The tapered recess and coupling protrusion 210 may be configured to form a Morse taper joint. Morse taper joints are sufficient to secure the articular body 66 to the glenoid base plate 100D. In some embodiments, additional fixation may be provided by a screw advanced through the articulating body 66 into the threaded hole 180B of the coupling protrusion 210. The screw may engage the screw through the threaded hole 180B as it travels from the open end 184B towards the closed end 188B. In some embodiments, the screw can travel into the threaded hole 180B of the coupling process 210 to result in the sole junction between the articular body 66 and the glenoid base plate 100D, which The screw engages the threaded hole 180B as it travels from the open end 184B towards the closed end 188B.

Terms As used herein, the relative terms "lateral" and "medial" are to be defined for biostructure. Therefore, the inside points in the direction toward the median line, and the outside points in the direction away from the median line.

Although specific embodiments and examples have been described herein, many aspects of the delivery system shown and described in this disclosure differ so as to form further embodiments or acceptable embodiments. It will be appreciated by those skilled in the art that they may be combined and / or modified. All such modifications and variations are intended to be included herein within the scope of this disclosure. A wide variety of designs and approaches are possible. The mechanisms, structures, or steps disclosed herein are not essential or essential.

For the purposes of the present disclosure, specific embodiments, advantages, and novel features are described herein. It will be appreciated that not all such benefits may necessarily be achieved according to any particular embodiment. Thus, for example, one of ordinary skill in the art achieves one benefit or group of benefits as taught herein, without necessarily achieving other benefits as taught or suggested herein. You will recognize that the disclosure may be embodied or implemented in the formula.

Moreover, although exemplary embodiments have been described herein, the scope of any and all embodiments will be equivalent elements, as will be appreciated by those of skill in the art under the present disclosure. , Modifications, omissions, combinations (eg, in aspects across various embodiments), conformances, and / or modifications. The limitation in the claims will be broadly interpreted based on the language adopted in the claims, and the examples will be interpreted as non-exclusive, as described herein. It is not limited to the examples to be performed, or the examples described during the examination of the application. Further, the actions of the disclosed processes and methods are modified in any manner, including by reordering the actions and / or inserting additional actions and / or deleting the actions. May be good. Accordingly, the specification and examples are to be construed as illustrative only and intended to indicate the true scope and intent by the claims and all their equivalents.

In particular, the conditions used herein, such as "can", "might", "may", and "eg (eg)". The language includes certain embodiments, but other embodiments, that include certain features, elements, and / or states, unless otherwise specified or otherwise understood within the context to be used. It is generally intended to convey that the form is not included. Thus, such conditional language as a whole requires more or less features, elements, blocks, and / or states for one or more embodiments, or is entered or prompted by the author. Whether by, or without input or prompting by the author, those features, elements, and / or states are included in any particular embodiment, or whether they are performed in any particular embodiment. It is not intended to suggest that one or more embodiments necessarily include logic for determining.

The scope disclosed herein also includes any and all overlaps, subordinate ranges, and combinations thereof. "Up to", "at least", "greater than", "less than", and "between", etc. The language includes the numbers listed. Numbers preceded by terms such as "about" or "approximately" should include the numbers listed and be interpreted on the basis of the situation (eg, as reasonably as possible under the circumstances). , For example, ± 1%, ± 5%, ± 10%, ± 15%, etc.). For example, "about 0.01 inch" includes "0.01 inch". Phrases preceded by terms such as "substantially" should include the described phrase and be interpreted on the basis of the situation (eg, as reasonably as possible under the circumstances). For example, "substantially linear" includes "linearly".

Claims (18)

A first side configured to engage the patient's scapula, a second side configured to face away from the first side, the first side and the first. A transverse body including a plurality of anchor apertures formed between the two side portions and a circular circumference extending between the first side portion and the second side portion. The traverse has an anterior portion configured to be oriented towards the anterior side of the scapula, a posterior portion configured to be oriented towards the posterior side of the scapula, and a center. With the body
An elongated body arranged along the vertical axis between the first end and the second end, the second end being coupled to the first side portion of the transverse body and said to be the first. The end of 1 comprises the slender body, which is located away from the second end.
The vertical axis of the elongated body is offset from the center around the circle towards its anterior portion.
Glenoid base plate. The glenoid base plate according to claim 1, wherein the transverse body further includes a threaded hole that facilitates attachment of the joint body to the glenoid base plate. The glenoid base plate according to claim 2, wherein the screw hole is arranged in the center around the circle. The glenoid base plate of claim 2, wherein the threaded hole is a blind hole having an open end on the second side of the transverse body and a closed end opposite to the open end. The glenoid base plate of claim 4, wherein the closed end of the blind hole is located between the first end of the transverse body and the first end of the elongated body. Further comprising a fastener body extending between the first and second ends, the second end is coupled to the first side of the transverse body, and the first end is. The glenoid base plate of claim 1, wherein the fastener body is disposed away from the transverse body and is aligned with a threaded hole in the transverse body. The glenoid base plate according to claim 6, wherein the fastener body extends from the side surface of the elongated body. The glenoid base plate of claim 1, wherein the circular perimeter of the transverse body comprises a tapered contour configured to coincide with a tapered recess in the articular body. The glenoid base plate of claim 1, wherein the anchor aperture is evenly distributed around the transverse body. The glenoid base plate according to claim 1, wherein the anchor aperture is evenly distributed around the aperture circumference of the transverse body, and the anterior portion of the aperture circumference opposite to the elongated body is formed without an aperture. .. An medial side configured to engage the patient's scapula, an lateral side configured to face away from the medial side, formed between the medial side and the lateral side. A transverse plate having a plurality of bone screw holes and a circular circumference extending between the medial side and the lateral side, wherein the circular circumference is oriented toward the anterior side of the scapula. The transverse plate having an anterior portion configured to be oriented, a posterior portion configured to be oriented towards the posterior lateral portion of the scapula, and a center.
Anchor pegs arranged along the vertical axis between an outer end coupled to the inner side of the traversing plate and an inner end disposed away from the outer end.
The vertical axis of the anchor peg is offset from the center around the circle towards its anterior portion.
Glenoid base plate. A transverse member having a medial side, an lateral side, anterior circumference, and posterior circumference, and a glenoid anchor having a protrusion extending from the medial side, wherein the protrusion is from the posterior circumference. Also located near the front circumference, the provision and
Forming a blind hole in the lateral portion of the scapula along a trajectory offset from the center of the lower portion of the glenoid fossa, wherein the blind hole is opposite to the opening in the glenoid and the opening. The closed end is spaced from the anterior surface of the scapula and the closed end is spaced from the posterior surface of the scapula.
To advance the protrusion of the glenoid anchor into the blind so that the protrusion is closed within the scapula along the blind between the opening and the closed end. When,
How to prepare. 12. It further comprises orienting the protrusion of the glenoid anchor towards the anterior portion of the edge of the glenoid before advancing the protrusion of the glenoid anchor into the blind hole. The method described in. Receiving image data in response to a scan of the patient's scapula,
From the image data, an anchor locus extending inward from the lateral surface of the scapula is identified, and the anchor locus is selected with respect to the anterior surface of the scapula and the posterior surface of the scapula. The identification and the above-mentioned identification in the position
The formation and provision of a glenoid anchor having a medial side, a transverse member having a perimeter, a lateral part, an anterior part, a posterior part bordering the medial side, and a protrusion extending from the medial side. ,
The protrusion is disposed within the perimeter at a position aligned with the identified anchor locus when the perimeter is aligned with the curvature of the inferior portion of the glenoid edge.
Method. 14. The method of claim 14, wherein the anchor locus is spaced from the anterior surface of the scapula. 14. The method of claim 14, wherein the anchor locus is spaced from the posterior surface of the scapula. 16. The method of claim 16, wherein the anchor locus is spaced from the anterior surface of the scapula. 14. The method of claim 14, wherein the glenoid anchor is formed such that the protrusion extending from the medial side is configured to extend through the opposing cortical bone of the scapula.

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